Longer Home Health Visits Tied to Lower Hospital Rates

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Home health care visits that are longerby just one minutemay be tied to lower hospital readmission rates. That’s the keyfinding from a recent study from the National Bureau of Economic Research (NBER).

“We obviously see an effect,” Guy David, associate professor at theUniversity of Pennsylvania’s Wharton School and author of the research, told Home Health Care News. “Shorter visits tend to increase the likelihood of readmissions.”

The study looked at data from an unnamed private, for-profit, multi-state home health care company with 96 offices in 16 states. The data spanned three years and eight months: January 2012 to August 2015.

“An extra minute relative to the average length of a patient’s home health visits reduces their readmission likelihood by approximately 8%,” the study found.

The results were opposite than what researchers expected to find, according to David, who anticipated that longer visits would indicate higher patient acuityand a greater likelihood of heading back to the hospital.

“One [thought] is that longer visits [are] associated with more readmissions—with sicker patients who require more attention and are [therefore] likely to be readmitted,” he said. “It’s interesting that we are seeing the opposite. The causal relationship runs in the other direction.”

The relationship between length of visit and readmission rates is a little more nuanced, though.

In the sample data, the average home health visit lasted 47 minutes, with each episode of care comprised of roughly 14 visits. Visits that were cut short because patients were determined to need inpatient care were not utilized in the data, nor were days in which a patient received more than one visit.

Home health visits can be cut short or vary in length for a number of reasons, including the workload of an aide or nurse and when the visit falls during the course of a day. For example, if a home health aide is running behind or they are on their last visit of the day, a visit could end up being marginally shorter. These variations alone won’t cause readmission rates to rise, but, together, they can have an effect, according to David.

With that in mind, providers should therefore focus on minimizing big variations in work schedules and look at the big picture of a patient care case and staff scheduling. This can be a significant challenge for many agencies with tightmargins and resources already crunched, as the industry has continually faced rate cuts to Medicare reimbursement over the last several years.

“It’s a tremendous amount of effort to figure out those operational efficiencies,” David said.

Refocusing health care resources

Despite the causal relationship, lengthening a home health visit by one minute likely won’t have a big impact—and readmissions rates won’t drop further by making visits exponentially longer. But lengthening every visit across all episodes of care could make a difference.

Furthermore, home health care agencies are already excellent at reducing readmissions. On average, 24% of home health episodes and just 2% of home health visits are followed by a hospital readmission, according to the study.

“The readmissions are also a relatively rare event. Not every patient gets readmitted,” David said. “So it’s 8% of a relatively small number. We definitely find an effect, but not a huge effect. It’s not an effect that you want to extrapolate.”

The bigger implications of the study—directed toward policymakers—may point to a greater need for further funding and flexibility in home health care, with agencies having more resources to spend more time with patients.

“It’s a small effect, but it moves in a very persistent way,” David said. “It may argue for the fact that the time spent with patients in the landscape of home health is insufficient. The health system is interested in reducing readmissions. This study highlights how important home health can be in achieving this goal.”

More resources diverted to the Medicare home health care segment would require incentives to shift slightly, away from hospitals and health systems—which are already penalized for readmissions under the Hospital Readmission Reduction Program (HRRP)—to post-acute providers. Currently, incentives are in place for home health care providers when they are tied to alternative payment models, such as bundled payments; in partnerships with major health systems and hospitals’ or in accountable care organizations (ACOs).

“If you want to be in a world where home health agencies care about reducing readmissions, you have to build that into their performance,” David said.

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